Becas Opportunity

Complete this form in English and use it to fill out the form at www.bit.ly/oppap19
In all amounts, use the exchange rate of $20 pesos per dollar.
Questions?: (55) 5703-0167 | educationusa.cdxm@comexus.org.mx

Personal Data
Male
Full Name:                         Female
Last First M.I.
Permanent Home Address:            
Street Address Apartment/Unit #
           
City/Town State/Province
Phone:       E-mail Address:      
N.I.
Date of Birth: mm/dd/yyyy Place of Birth:       Number:      

First Language:       Language spoken at home:      

Other Country’s Citizenship
Citizenship: <Country> Citizen Dual US/<Country> Citizen      
YES NO If yes,
Have you ever applied for a US visa? when?       Was the visa granted? YES NO

If yes, what type of visa?      

YES NO If yes, please explain relationship
Do you have relatives in the US?      
Marital
Status: Single Married Widowed Separated Divorced
Possible area(s) of
academic concentration:       Undecided
Possible career or
professional plans:       Undecided

Will you be a candidate for financial aid? YES NO

Education
Institution you
now attend:       Address:      
Date of Date of Home
Entry:       Graduation:       Type of School: Public Private Municipal School

Degree(s) Obtained: High School Diploma Date:       Licenciatura/Ingeniería (B.A./B.S.) Date:      

Masters (M.A./M.S.) Date:       Doctorate (Ph.D.) Date:      

List all academic institutions and other programs you have attended since ninth grade

Location (City, Country) Name of School Dates Attended

                 

                 

                 

List all colleges/universities at which you have taken courses for credit
Degree(s)
Location (City, Country) Name of College/University Dates Attended Earned

                       

                       

                       

Not currently attending school

 Test Information
Test of English as a
second language
(TOEFL) Test: ITP Date taken:       Score:      

GRE General Date taken:       Verbal:       Quantitative:       Analytical Writing:      

GMAT Date taken:       Verbal:       Quantitative:       Analytical Writing:      

SAT I Date taken:       Verbal:       Math:       Writing:      

SAT II Subject Tests Date taken:       Subject:       Score:      

Date taken:       Subject:       Score:      

Date taken:       Subject:       Score:      

Combination
English: Math: Reading: Science: Composite: English/Writing:
ACT Date taken:                                          

If any other tests taken: Test:       Date taken:       Score:      

Family
Male
Parent/Guardian 1:                   Female
Last First M.I.
Mother Father Legal Guardian Living? Yes No Date deceased:      

Home address if different from yours:      

Home phone:      

E-mail:      

Occupation:      

Name of employer:      

High School/University (if any):      

Highest degree obtained:       Year:      

Male
Parent/Guardian 2:                   Female
Last First M.I.
Mother Father Legal Guardian Living? Yes No Date deceased:      

Home address if different from yours:      

Home phone:      

E-mail:      

Occupation:      

Name of employer:      

High School/University (if any):      

Highest degree obtained:       Year:      

Parents' Marital Separa
Status: Never Married Married Widowed ted Divorced

With whom do you make your permanent home? Parent 1 Parent 2 Both Other

Please give information on all the family members living in your household who are dependant on your parents
(include yourself)
Year in
Relationship to Name of school or school or Cost of Amount paid by
Name Age you college college education /year Scholarships parents

                              $             $      

                              $             $      

                              $             $      

                              $             $      

Academic Honors & Extra curricular Activities

Briefly list or describe any academic distinctions or honors you have received since the ninth grade

     

Briefly list or describe any extracurricular activities / social projects that you have been involved since the ninth grade

     

Work Experience

Please list principal jobs you have held during the past three years, including summer employment
Hours per
Type of Work Employer Approximate Dates week

                       

                       

                       

 Financial Information

Please indicate how much of your family´s income came from the sources listed below during 2017

Father´s work $       Family business $       Interests or dividends $      

Housing, food and
Mother´s work $       Family real estate holdings $       other living allowances $      

Your work $       Pension/annuity/retirement $       Other (explain below) $      

Other members of the
Your spouse’s work $       household $       __________________________________

Will there be a significant increase in your family’s income next year? Yes       No       If yes, explain:      

Does your family own the home you currently live in? Yes       No       If yes, please respond below
How much does your family still owe on the purchase
What year was it purchased?       price?      

What was the original purchase price?       What is the present market value?      

Does your family own any other type of property or estate? Yes       No       If yes, indicate type and value:      

Does your family own a business? Yes       No       If yes, please respond below

Date business commenced       Your parents’ share of business value $      
Your parents’ share of business
Type of business       indebtedness $      

Please indicate the value of the following family assets (if applicable):
Land and buildings (other than
home or business) $       Assets owned by students $      
Indebtedness on land and
buildings $       Money owed to family by others $      
Repayment expected this year (of
Savings $       previous item) $      
Investments (bank deposits, Other (jewelry, artwork, antiquest,
stocks, bonds etc) $       etc) $      

Please list all the banks your family has accounts in, type of account (checking, savings) and the average balanc

           

           

           

Do you or your family own an automobile(s)? Yes       No       If yes, please answer below:

Make (Toyota, Nissan, etc)       Year of manufacture      

How much did your family spend on the following expenses during 2017? Please enter SPECIFIC AMOUNTS
Amount allocated to
Rent or mortgage $       savings/retirement $      

Utilities (water, gas, power, phone) $       Automobile maintenance $      

Food $       Insurance (health/property) $      

Clothing $       Entertainment $      

Household necessities $       Vacations $      

 Medical expenses $       Servants $      

Loan payments $       Other $      

Taxes $       Please explain:      

How much money does your family owe to other people or financial institutions? $      

Reason for debt:       Amount paid in 2017 $      

Does your family employ other people? Yes       No       If yes, how many in the home?       In the family business?     

Personal Statement
Please include an essay that describes your background –personal, academic, extracurricular-, your
accomplishments, extraordinary skills and your goals. This essay should not exceed 500 words.